靶控静脉麻醉对老年腹部手术患者围手术期血流动力学和应激反应以及苏醒质量的影响

doi:10.3969/j.issn.1674-490X.2018.03.003

摘要/Abstract

摘要： 目的探讨靶控静脉麻醉对老年腹部手术患者围手术期血流动力学和应激反应以及苏醒质量的影响。方法 2016年3月至2017年9月选取拟行腹部手术治疗的老年患者120例,随机分成观察组和对照组,各60例。观察组给予丙泊酚复合舒芬太尼靶控静脉麻醉,对照组给予芬太尼复合2.5%异氟醚静吸复合麻醉,观察2组麻醉前(T0)、诱导插管后(T1)、拔管时(T2)和拔管后10 min(T3)的平均动脉压(MAP)、心率(HR)等血流动力学指标和内皮素(ET)、皮质醇(Cor)等应激指标变化,以及自主呼吸恢复时间、呼之睁眼时间、完全清醒时间、拔管时间、Steward苏醒评分等苏醒质量指标。结果 T0和T3时,2组MAP、HR水平比较,差异无统计学意义(P>0.05);T1~T2时,观察组MAP、HR水平明显低于对照组,比较差异有统计学意义(P<0.05);2组T0时,ET、Cor水平比较,差异无统计学意义(P>0.05);T1~T3时,观察组ET、Cor水平明显低于对照组,比较差异有统计学意义(P<0.05);观察组自主呼吸恢复时间、呼之睁眼时间、完全清醒时间、拔管时间和Steward 苏醒评分等苏醒质量指标均明显优于对照组,比较差异有统计学意义(P<0.05)。结论丙泊酚复合舒太芬尼靶控静脉麻醉能明显减轻老年腹部手术患者围手术期血流动力学变化和应激反应,提高患者苏醒质量。

关键词: 靶控静脉麻醉, 老年, 血流动力学, 应激反应

Abstract: Objective To investigate the effects of target-controlled intravenous anesthesia on hemodynamics, stress response and recovery quality during perioperative period in elderly patients undergoing abdominal surgery. Methods 120 elderly patients who were treated with abdominal surgery in March 2016-September 2017 were randomly divided into observation group and control group(60 cases in each group). The patients in observation group were given propofol-fentanyl combined with target-controlled intravenous anesthesia, the patients in control group were given fentanyl combined with 2.5% isoflurane inhalation combined anesthesia, the average arterial pressure(MAP), heart rate(HR), and 4 periods of 10min(T3)were observed in two groups before anesthesia(T0), induced intubation(T1), extubation(T2)and extubation. The hemodynamic indexes such as blood oxygen saturation(SpO₂)and the changes of stress indexes such as endothelin(ET)and cortisol(Cor), as well as the recovery quality indexes such as the time of spontaneous respiration, the open time, the full awake time, the extubation time and the steward awakening score. Results T0 and T3, there was no statistically significant difference between the two groups of map and HR levels(P>0.05). T1-T2, the observation group map, the HR level was obviously lower than that of the control group, the comparison difference had the statistical significance(P<0.05). There was no statistically significant difference between ET and Cor levels in the two groups of T0(P>0.05). T1-T3, the level of ET and Cor in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The recovery quality indexes of the observation group were significantly superior to those of the control group, such as the time of spontaneous respiration, the open time, the full awake time, the extubation time and the steward recovery score, and the difference was statistically significant(P<0.05). Conclusion Propofol combined with Shutefini target-controlled intravenous anesthesia can significantly reduce the perioperative hemodynamic changes and stress responses in elderly patients with abdominal surgery.

Key words: target-controlled intravenous anesthesia, elderly, hemodynamics, stress response

中图分类号:

何志刚,姜娟. 靶控静脉麻醉对老年腹部手术患者围手术期血流动力学和应激反应以及苏醒质量的影响[J]. 医学研究与教育, 2018, 35(3): 20-25.

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